The first signs of cervical cancer. Manifestations and diagnostic methods. Methods for determining cervical cancer Leaking cervical cancer
![The first signs of cervical cancer. Manifestations and diagnostic methods. Methods for determining cervical cancer Leaking cervical cancer](https://i0.wp.com/pro-rak.com/wp-content/uploads/2018/02/56656465456645465.jpg)
Cervical cancer (CC) or cervical carcinoma (ICD 10 - C53) is a malignant tumor that forms in the cervical region. Why does this disease develop and what are its consequences? Today, these questions are of concern to almost all women on the planet, since this disease has become very common - it ranks second in frequency of malignant formation after breast cancer and is observed in every 10 women per 100,000 cases.
Every year, 600,000 females are diagnosed with cervical cancer, while the risk of the disease in women of Hispanic origin is much higher than in Europeans. According to statistics, the probability of encountering cervical carcinoma in patients who are over 40 years old is 20 times higher - in 65% of cases from 40 to 60 years old, in 25% from 60 to 70 years old.
Many people wonder how long they live if the disease is detected at stage 1? If the pathology is found in the age range from 25 to 45 years, then the disease can be completely cured (90%). Early stages of such a disease are diagnosed in Russia in 15% of women, late stages - in 40% of patients.
The harbinger of this malignant neoplasia is the process of transformation of the structure of the cervix, resulting in dysplasia of the upper layers of its epithelium. In the absence of treatment, the disease begins to progress initially to a non-invasive stage, and only later to an invasive tumor ( definition of stages is given below).
In the Russian Federation, the non-invasive form of cervical cancer is diagnosed 4 times more often. At the same time, with the help of new methods for recognizing this disease in the early stages (screening tests), it was possible to significantly reduce the mortality of patients due to this pathology.
What is the cervix?
The cervix is the lower and narrowest part of the uterus (an organ consisting of smooth muscle and designed for bearing a fetus). In appearance, it looks like a cylinder that passes the cervical canal through itself; in terms of structure, it consists of tissue enriched with collagen and muscle fibers.
Leading clinics in Israel
The cervix is divided into 2 sections:
- the area above the vagina;
- vaginal part (1/3 of the cervix).
In the walls of the uterine isthmus there are tubular glands that secrete a mucus-like substance that does not allow harmful microorganisms to penetrate from the vagina into the uterus. Ridges and folds perform a similar function inside the canal. The size of the cervix is no more than three centimeters long and 2.5 centimeters wide. Depending on the menstrual cycle, its size and structure undergo changes.
disease factors
Considering the main causes contributing to the development of cervical cancer, doctors came to the conclusion that the presence of HPV (human papillomavirus) plays a significant role in this process. The method of transmission of the virus is sexual intercourse (even protected) with an infected person, or contact through the skin and mucous membranes. As a result, HPV introduces its code into the DNA of epithelial cells, which leads to their inability to carry out healthy functions.
The consequence of this is the formation of malignant tumor cells (), which eventually begins to grow into neighboring organs and metastasize throughout the body.
At the same time, high-risk oncogenic HPVs are human papillomavirus types 16 and 18 (in 70% of cases).
Other etiological factors that cause cervical cancer are:
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The risk group also includes women working with carcinogens.
Symptoms of cervical cancer
What is the clinical picture of cervical cancer? The peculiarity of the symptoms of cervical cancer is that at the beginning of its development, the disease practically does not manifest itself in any way. This is a very unfavorable fact, since it is the timely and early diagnosis and treatment of this disease that can save the life of the patient.
The main signs of this pathology in the embryonic stage are:
- constant spotting, including blood between menstrual cycles, after douching and going to the gynecologist;
- causeless increase in body temperature above 37 degrees;
- specific brown or pink discharge that appears after sexual contact;
- menstrual disorders;
- pain in the lower abdomen, especially after sexual intercourse;
- prolonged bleeding during menstruation.
Symptoms of cervical cancer at a relatively late stage are accompanied by such phenomena as:
![](https://i2.wp.com/pro-rak.com/wp-content/uploads/2018/02/56656465456645465-300x196.jpg)
CC often causes severe impairment of kidney function, when, against the background of their inability to provide urine outflow, there is a progressive expansion of the renal pelvis and atrophy of the tissues responsible for the accumulation of urine (hydronephrosis).
Related video (from 30:40)
The mechanism of growth of cervical cancer
How quickly does the disease develop? The physiological process of malignancy (malignancy) of the disease is characterized by the following stages:
- epithelial cells begin to respond to damage and actively divide in order to restore tissue;
- the process of transformation begins by disrupting the structure of the layers of the epithelium, the so-called dysplasia;
- over time, malignant formations appear inside the cells, which trigger the mechanism of uncontrolled division of the epithelium, which marks the onset of the stage of pre-invasive or non-invasive cervical cancer (cancer in situ or "cancer in situ");
- malignant neoplasia grows into the underlying tissue of the cervix. If its size is less than three millimeters, it is considered a microinvasive carcinoma (first stage of invasive formation);
- reaching a tumor size of more than 3 mm, giving rise to the development of an invasive form of cervical cancer. The predominant part of patients is faced with clinical symptoms of the disease at this stage.
Classification of cervical cancer
Depending on the internal and external transformation of the epithelium, which ultimately forms one or another type of malignant formation, it is customary to distinguish the following forms of cervical cancer:
- squamous cell malignant oncology with keratinization (from 83 to 97% of cases);
- squamous without keratinization (from 60 to 65% of cases);
- poorly differentiated (from 20 to 25% of cases);
- or glandular form of cervical cancer (from 4 to 16% of cases);
- other less common forms: mucoepidermoid, small cell and clear cell (from one to two percent of cases).
Based on the degree and direction of development of carcinoma, such types are distinguished as:
- preinvasive or intraepithelial;
- non-invasive (slow growth of pathological cells exclusively in the cervical region, treatable);
- microinvasive (low probability of metastases);
- exophytic (the formation grows inside the vagina, uterus and appendages). The most common form, diagnosed at the earliest stage;
- endophytic (onconeoplasia that forms inside the cervical canal). In appearance, it looks like an ulcer that bleeds on any contact. Growth occurs in the uterine body.
Stages of cervical cancer
The transition of a precancerous condition into a cancerous one takes from two to ten years, the development of a tumor of the first stage into the next lasts about two years. To determine the degree of prevalence of cancer, damage to the lymph nodes and other organs, the classification developed by the International Federation of Obstetricians and Gynecologists or FIGO is used.
Stage zero
Oncocells are localized exclusively on the surface of the mucous membranes of the cervical canal, without penetrating inside (cervical intraepithelial neoplasia).
With early diagnosis, the prognosis for survival is 100%;
First stage (cancer colli uteri)
The process of pathological growth of cancer cells within the cervix itself. The defeats are as follows:
- an invasive tumor with a diameter of three to five millimeters, with a depth of up to seven millimeters (substage IA) and a diameter of more than five millimeters, with a depth of seven millimeters to four centimeters (substage I-B). Diagnosed under a microscope, by taking a smear from the cervical canal for cytological analysis;
- a visible mass larger than four centimeters (substage IB2).
Second stage
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This stage is diagnosed by colposcope, scraping of the upper epithelium, ultrasound examination of the pelvic organs, cytological examination or wedge-shaped biopsy (an electric loop capable of extracting tissues from a deep layer of tissues).
Third stage
The tumor grows into the pelvis and vagina. It affects nearby lymph nodes and prevents urination, while not touching neighboring organs. Large in size.
- the mass penetrates into the lower part of the vagina, but does not affect the walls of the pelvis (IIIA);
- the tumor obstructs the ureters, damages the functioning of the lymph nodes in the pelvis, and affects the walls of the uterus (IIIB).
Detection of cancer occurs using the method of colposcopy, biopsy, CT x-rays and MRI (magnetic resonance imaging).
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Fourth stage
The formation becomes large and grows around the uterine isthmus with simultaneous damage to neighboring and distant organs, as well as the system of lymph nodes.
![](https://i0.wp.com/pro-rak.com/wp-content/uploads/2018/02/223165465.jpg)
To diagnose the patient's condition at this stage, an examination, an endoscopy of the intestinal tract, computed tomography or MRI is performed. In order to detect metastases, positron emission computed tomography (PET-CT) is performed.
Diagnostic methods
If there is a suspicion of cervical cancer, the diagnosis process is carried out by the following methods:
- passing a gynecological examination with the removal of a smear to identify microflora and the presence of oncocells;
- the appointment of blood tests, the detection of HPV, the study of vaginal discharge;
- examination with a colposcope, X-ray, excretory urography, ultrasound, MRI and computed tomography;
- cytological study.
The most recognized method of analysis is Papanicolaou testing (Pap test), carried out by removing the discharge from the uterine mucosa with a special device. The study is carried out within 7 days. The analysis is carried out on the fifth day of menstruation and five days before menstruation. One day before his delivery, it is forbidden to have sexual contact and douche.
Methods of treatment
If you ask yourself whether this disease can be treated, whether it is possible to defeat the disease, then the question lies in the plane of its stages. To date, the preferred treatment for cervical cancer is radiation or surgery, which equally give the same effect. For young girls, an operation is indicated that minimizes the risk of ovarian dysfunction. The types of treatment at different stages are:
- an operating method, which consists in carrying out a laparoscopy procedure that allows you not to injure internal organs. Hospitalization is three to five days;
- , which is carried out in order to reduce the size of the formation and its further resection. The consequences of this type of therapy can be vaginal atrophy, infertility, approaching menopause, damage to the walls of the vagina and, as a result, a violation of the process of urination and defecation;
- with the use of Cisplatin preparations in order to reduce the size of the tumor, and sometimes as an independent therapy.
Modernized treatments include:
![](https://i1.wp.com/pro-rak.com/wp-content/uploads/2018/02/135546546654853.jpg)
What is the danger of the disease?
Oncologists identify a number of consequences that can be caused by cervical carcinoma, including:
- removal of the entire uterus, vagina, intestines and bladder. The key task in this case is life extension;
- in case of damage to the reproductive organs, resection of the uterus, ovaries and vagina is carried out. In this situation, a woman is deprived of the opportunity to become a mother in the future;
- removal of only the uterus with the preservation of the appendages;
- elimination of the cervical canal;
- removal of the vagina, with the subsequent inability to have sex;
- resection of the uterus - in this case, the woman will never be able to give birth.
Preventive measures
Preventive actions to prevent the development of cervical cancer are:
![](https://i0.wp.com/pro-rak.com/wp-content/uploads/2018/02/87946346513123654.jpg)
To substantially reduce the risk of cervical cancer, medical advice is to get the human papillomavirus vaccine using a drug called Gardasil, a four-part vaccine designed against the HPV types that cause cervical cancer (6,16,18,11). It was registered in the Russian Federation in 2006. This medicine includes similar viruses that produce antibodies. The term of immunity is 3 years. Its use is indicated for girls in the age range of nine to seventeen years and only for those women who are not yet infected with HPV.
The price for one vaccination course is around $450. The vaccine is administered for the first time, then two months later, after six months and a control one at the age of 26-27 years.
Video: How cervical cancer is diagnosed and treated
Content
Regular examinations by a gynecologist should become a habit for a woman whose body has made it known that she is ready for childbearing, since the state of the reproductive system is no less important than the state of other organs. A common disease is cervical cancer - a pathology with pronounced symptoms, which is important to identify at an early stage, since an unfavorable outcome in case of late diagnosis is not excluded. Why does a low-quality education appear in this area and can it be cured?
What is cervical cancer
Doctors use the term "cancer" for neoplasms of a low-quality type - tumors that can pose a threat to a person's life. Their key nuance is the rapid division of cells, and their subsequent settling on the tissues adjacent to the focus of pathology. After that, the appearance of metastases in nearby organs is not excluded. If the appearance of cancer cells is observed in the area of \u200b\u200bcombining the uterus with the vagina or in its lower third, doctors talk about malignant tumors of the uterine cervix.
A few points of such cancer:
- According to gynecologists, the main risk group is women who are in the premenopausal period - the age of 45 years and older. The upper age limit is 55 years, but about 20% of patients with oncology are over 65 years old.
- Cervical cancer is the most common type of neoplasm on the organs of the female reproductive system, and in the current century, the rate has increased by 37% compared to the previous one.
ICD-10 code
In the international classification of diseases developed by the World Health Organization and since 2007, adopted as the main one among doctors, malignant pathology is classified as class II - neoplasms. This disease has been assigned code C53, but there are 4 more subcategories in it with additional markings:
- C53.0 speaks of malignant tumors that have appeared in the inner part.
- C53.1 assigned to the tumor on the outside.
- C53.8 is a tumor that is outside of these areas.
- C53.9 is rare, because it indicates the impossibility of specifying the localization of the neoplasm.
Symptoms
Even in the case of regular examinations, the gynecologist has a risk of missing the onset of the development of the disease, since he is deprived of characteristic signs that would help to separate him from other diseases of the genital membrane. A woman may experience an increase in body temperature, but within subfebrile, which will be attributed to hypothermia, stress, etc. Fatigue and weakness are also mainly explained by external factors. However, you should be wary if:
- frequent fainting;
- dizziness;
- loss of appetite;
- weight loss.
Allocations
Specific signs of oncology of the female organs are spotting that is not associated with the menstrual cycle. A number of women experience them after intercourse, but in most situations they are difficult to associate with anything. The nature of the discharge can also vary: from weak, smearing, to abundant, as during menstruation. With endometrial cancer, they are odorless, but if the tumor has passed through the mucous membrane of the cervical canal down into the vagina, they are characterized by a pungent odor.
pain
Among the characteristic signs of the presence of a malignant tumor in the uterine neck, gynecologists also distinguish pain, mainly localized in the pelvic area. They can:
- appear after intercourse;
- be sudden;
- accompany the menstrual cycle.
Signs at an early stage
It is difficult to independently determine this pathology at the time of the appearance and growth of malignant cells: you can only notice a number of minor problems that are inherent not only in oncology, but also in a number of diseases of the genital organs. This pathology can manifest itself:
- a feeling of constant discomfort in the area of the vagina and labia;
- watery vaginal discharge;
- menstrual irregularities.
late symptoms
As a cancerous tumor on the uterine neck develops, it begins to affect adjacent organs, and the cells begin to disintegrate, which leads to the appearance of additional symptoms that are already easier to associate with this pathology:
- problems with urination due to pressure on the bladder;
- the appearance of pus in bloody discharge;
- pain in the sacrum;
- lymphostasis;
- swollen lymph nodes;
- anemia.
Causes
According to the data of gynecologists and studies that have been conducted in the last century, there is a strong relationship between neoplasms in / on the uterine neck and the activity of a woman's sexual life. With a frequent change of sexual partners, the risk of a neoplasm increases. However, this is not the only reason - the pathology often develops against the background of the following precancerous diseases:
- epithelial dysplasia;
- epithelial neoplasia.
These diseases also do not arise from scratch - they are mainly provoked by HPV viruses (only stamps numbered 16 and 18). However, doctors note a whole list of factors that are secondary causes of the tumor - they increase the risk of oncology. Among them:
- several abortions;
- early onset of sexual activity and pregnancy (up to 16 years);
- congenital pathologies of the uterus and other organs of the reproductive system;
- infections introduced into the genitals;
- trauma to the uterine cervix during childbirth;
- long-term use of hormonal drugs;
- erosion;
- abuse of nicotine;
- radiation exposure.
How fast is developing
Primary weak signs may disturb a woman for a long time, since the growth rate of malignant cells in the uterine cervix is low. The duration of the spread of the tumor through the uterus and down to the vaginal mucosa can be 20 years. However, the number of factors influencing this indicator is large: external prerequisites, the type of tumor are key, but not the only ones. The minimum period of transition from one stage to another is 2 years.
What is dangerous
This pathology has many terrible consequences: hysterectomy or amputation of the uterus, which leads to the woman’s inability to give birth to a child, but the body is completely removed only in extreme cases, especially if they are dealing with a patient who has not given birth. If you do not consider surgical intervention, the main problem of oncology is unpredictability: in the worst case, a fatal outcome is possible.
Kinds
In gynecology, only 2 forms of this oncology are distinguished, which are based on the affected area:
- If the tumor spreads from the fundus of the uterus, it is a squamous cell carcinoma. According to the symptoms, it can look almost the same as the cervical one. In most cases, patients have polymorphic changes in cells.
- If the cells that cover the cervical canal are affected, doctors talk about cervical carcinoma. At the initial stages, there are no obvious signs, which leads to late diagnosis of the pathology.
stages
Oncology cannot immediately manifest itself in a severe form. If it affects the lower sector of the uterus, doctors distinguish 4 stages of development, between which several years can pass:
- Preinvasive cancer (intraepithelial) is an early stage in which the tumor affects only the upper layer of the epithelium. If the pathology is recognized at this moment, only a small affected area will have to be removed.
- Non-invasive - the tumor spreads deep into the glandular epithelium, but remains inside the uterus.
- Invasive - already affects the vaginal cavity (the upper part bordering the neck), the size of the tumor is seriously increasing. Additionally, the body of the uterus, parametrium can be affected. In patients with this form, the chances of a successful cure are 50%.
- The last stage also affects the lower vaginal area. It is not excluded the formation of cancerous tumors on the pelvic organs, the spread of metastases to the lymph nodes in this area.
Diagnostics
All examinations begin with a classic examination by a gynecologist, who can notice even the slightest deviations from the norm and send them for additional checks. Stage zero changes in the lower part of the vagina are not typical, so a number of procedures will have to be completed to detect cancer:
- Colposcopy is the main method of studying the walls of the vagina and the entrance to the cervix.
- In the early stages, cytological diagnostics is also prescribed. If an additional examination of the cervical mucosa is needed, special tests are performed using medications or a probe.
- A tissue biopsy is performed when atypical cells and vessels are suspected.
- Curettage of the cervical canal helps to study the condition of the endometrium.
- Sigmoidoscopy - will be carried out only when the diagnosis is confirmed, is a study of the mucous membranes of the rectum.
Based on a cytological smear, an initial examination using palpation, the use of gynecological mirrors and a colposcope, the doctor makes a conclusion, after which he can give direction for several more checks:
- Chest x-ray (to exclude the risk of detecting lung metastases);
Analysis for cancer cells
The main laboratory test for oncological disease of the uterine neck, gynecologists call cytological diagnostics, in which a dye is applied to the resulting smear in order to reveal the affected cells. However, this is not the only test that a woman needs to pass in order to contribute to the early detection of cancer: it will also be necessary to study the composition of the blood for the presence of viruses.
Is there a cure for cervical cancer?
If you managed to notice the first moments when the pathology began to appear, and consult a doctor at an early stage, the chances of a cure and stop the spread of cancer cells are high. The mucosal area that has already been infected will be removed, and then a long-term medication will be needed to prevent the formation of a new tumor focus. However, not every case of cancer is solved so easily.
Treatment
If a precancerous condition is detected, cryosurgery can be limited - infected cells will be frozen and removed. After that, the treatment of cancer is already more complex and mainly involves surgical intervention. The main ways to fight cancer:
- If the cancer is squamous, the doctor will advise radiation therapy: it will be carried out externally and internally (into the vagina and uterus). The duration of the course is up to 2 months.
- Cervical conization - consists in the surgical removal of tissues of the cervical canal and uterus.
- Radiation therapy and chemotherapy are used together if the tumor has not reached the walls of the pelvis. At stage 3 and beyond, this combination is less effective.
- Solo chemotherapy is recommended for stage 4 cancers when lymph node lesions and adnexa are affected.
- Immunotherapy is a newer approach that aims to avoid hysterectomy, but should complement radiotherapy.
- Trachelectomy - removal of only the cervix, which is practiced at the 1st stage of cervical carcinoma.
- Extirpation of the uterus - amputation of the cervix and body. If the tumor has spread actively, an extended extirpation with appendages in case of malignant neoplasms on them may be required, with removal of the lymph nodes, but without removal of the ovaries.
Forecast
Gynecologists say that oncology of the uterine cervix is curable in most cases: even at a late stage, the chance of survival in cancer patients is more than 70%, but not all doctors share this opinion. A number of them are inclined to believe that at the last stage only 7.8% of cancer cases will not end in death, at earlier stages the situation looks less terrible. Even after treatment, relapses are possible.
Cervical cancer and pregnancy
Any doctor will offer treatment for a woman who is carrying a child in the same way as for a non-pregnant woman, but with mandatory constant monitoring in the clinic. In the 1st trimester, a medical termination of pregnancy is possible, after which - waiting for delivery. After 2 months, it will be possible to carry out excision of uterine tissues and other surgical interventions. After the elimination of cancer, pregnancy can only be planned after 2 years.
Prevention
The main measure of protection is regular visits to the gynecologist: even in the initial stages, cervical cancer is clearly visible during a classic examination. Additionally required:
- protection during sexual intercourse;
- screening examinations;
- treatment of dysplasia when detected.
Is the vaccine effective?
The main cause of this oncology is the papillomavirus, against which doctors recommend vaccination, preferably in adolescence, since early sexual intercourse is a key risk factor. However, the effectiveness of vaccination is only 70%, and if the body is sensitive to the components of the vaccine, the vaccine can become dangerous to health.
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Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.
Did you find an error in the text? Select it, press Ctrl + Enter and we'll fix it!The very name of the disease terrifies a woman. This is understandable: cervical cancer is deadly and in the later stages there is practically no cure. But the disease can be overcome if it is detected on time and has not yet been launched. The insidiousness of the disease lies in the fact that it does not manifest itself in any way at first. Although this is a rather controversial statement. After all, there are some distinct first signs that you just need to pay attention to. They will be discussed in the article.
What causes cervical cancer
The causative agent of the disease is most often the banal human papillomavirus, abbreviated as HPV. This is just one of those sexually transmitted infections (STIs). Not all infections cause cervical cancer. A similar danger is more often represented by HPV, a highly contagious virus. It also does not necessarily turn out in a similar deplorable way, the infection can disappear on its own or be cured. And it can cause abnormal cell growth. Which leads to cancer.
A special risk lies in the fact that the onset of the pathological process cannot be noticed, such as, for example, a tumor in the mammary gland. However, there are symptoms that should never be ignored. A woman must definitely go to an appointment with a gynecologist and undergo a full examination if she finds at least one of the signs described below.
The appearance of unusual secretions
Ordinary light discharge is the norm for any adult woman. But if they become too profuse, watery, the color is dirty pink or greenish; if they appear during the intermenstrual period or due to heavy lifting, after sexual intercourse, etc., this may be a sign of a tumor.
warts
Any neoplasms, internal or external, should alert and force an analysis for the presence of cancer cells. Warts are not as harmless as they might seem, they can signal the onset of a tumor process.
Bleeding and pain
Everything that is out of the ordinary should be alarming. The appearance of any bleeding - from the vagina, bladder or intestines - may indicate the risk of cervical cancer. The tumor begins to grow on the walls of the uterus, the tissue begins to dry out and even crack, which inevitably causes discomfort and pain, as well as spotting.
Anemia
You continue to eat as usual, do not change your lifestyle and do not increase the amount of physical activity, but at the same time you began to get tired quickly, feel tachycardia for no apparent reason. These are all signs of anemia. Anemia is one of the early symptoms of cervical cancer. This can be caused by extraordinary bleeding with significant loss of blood, and the general state of weakness that occurs with oncological diseases.
Problems with urination
Difficulty urinating can occur because the growing cancer cells cause the uterus to enlarge and swell. It, in turn, puts pressure on the bladder and kidneys, which prevents the free passage of urine throughout the system. Often women notice that the bladder does not empty completely. This is an occasion to tune in and urgently be examined by a urologist and an oncologist.
Pain in the back or legs
In these cases, we look for the cause in the joints or spine. This is correct, but it would be nice to get tested for possible cervical cancer. A tumor of the uterus compresses the internal organs, compresses the blood vessels, and the blood cannot move freely through the vessels of the legs and small pelvis. The result is pain, swelling of the legs and ankles.
Dramatic weight loss
In most forms of cancer, there is a decrease in appetite and rapid weight loss of a person. Swelling of the cervix, which occurs with oncology, compresses the internal organs. It is difficult for the patient to take food in normal volumes, his appetite disappears, respectively, his weight falls. By the way, a sharp weight loss is one of the signs that appear outwardly and even attract the attention of others. This should be a signal that you need to urgently undergo an examination and pass all the relevant tests.
Just don't panic
It is not necessary to think that all of the listed signs necessarily indicate the presence of a cancerous tumor. This is just a signal that it is time to undergo an examination and exclude the disease, and if it exists, start treatment in the early stages, when the cancer is still curable.
And yet, everyone should remember about the factors that provoke cancer. Specifically, cervical cancer. This:
- Smoking, including passive smoking, when someone nearby smokes all the time.
- Chaotic sex life.
- Unprotected sex.
- Weak immunity.
Sexually transmitted infections are the most likely and common cause of the disease. This must be remembered, and special attention should be paid to the timely treatment of the human papillomavirus. As a preventive measure, a healthy woman should have tests and a Pap smear, or Pap smear, at least once a year. This is a simple, quick and painless way to detect the development of cervical cancer at an early stage. When it comes to health, there should be no place for laziness and carelessness. Take care of yourself.
This is an oncological disease in which a malignant degeneration of the mucous membrane of the cervix is diagnosed. In terms of the frequency of clinically detected cases, cervical cancer surpasses only breast cancer and endometrial cancer.
The main risk area for developing cervical cancer is women between the ages of 40 and 55. But, lately, the disease is catastrophically younger. Increasingly, cervical cancer (cervical cancer) is diagnosed in patients younger than 30 years. There is another problem - untimely diagnosis. Although the disease is quite easy to identify, in more than half of the cases of cervical cancer is found already in the later stages. If you suspect a disease, you should immediately consult a gynecologist.
Types of cervical cancer
The main classification of cervical cancer follows from the type of tissue affected by the tumor. The topmost and protective layer is the squamous epithelium. In this case, we can talk about the following forms:
- Dysplasia (it can have 3 degrees) - a precancerous condition;
- cancer in situ. This is the name of the degree of the tumor with minimal germination in other layers;
- Squamous cell carcinoma of the uterus.
Directly in squamous cell carcinoma of the cervix, the following varieties can appear:
- papillary;
- Warty;
- keratinizing;
- non-keratinizing;
- Lymphoepithelioma-like;
- Basaloid;
- Squamous transitional.
Tumors that affect the secreting epithelium are called adenocarcinomas. They can be:
- endometrioid;
- serous;
- Clear cell;
- mesonephric;
- Mucinous.
Often, the process is accompanied by the formation of concomitant tumors of other etiologies:
- Neuroendocrine and large cell carcinomas;
- Carcinoids;
- Sarcomas;
- Small cell cervical cancer.
Classification of forms of cancer
Cancer is distinguished by its location (the vaginal part of the cervix and the inner part). In addition, there are several forms of growth:
- Pre-invasive. In this case, the zero stage is assigned. The malignant process develops strictly inside the epithelium;
- Microinvasive. The depth of the lesion does not exceed 0.5 cm, without metastases;
- Non-invasive (stage 1). Cervical cancer cells are not widespread and progress very slowly;
- Exophytic. The most common type, in which the tumor grows in the lumen of the vagina. Outwardly, it resembles a cauliflower fork. This is stage 3 (with damage to the tissues of the vagina). At stage 4, metastases to various organs can be observed;
- Endophytic. The tumor grows secretly in the cervical canal. It becomes noticeable only in the later stages of tumor decay, leading to friability and unevenness of the cervix. Outwardly, it is defined as a bleeding ulcer that grows deep into the tissues of the uterus;
- Mixed. This is a rather rare option, since it involves the presence of several tumors of various types at once.
Causes
The main threat of cervical cancer in women is viruses that lead to mutations and the degeneration of healthy tissue cells into malignant tumors. Risk factor #1 is the human papillomavirus (HPV). But this virus has more than 100 varieties with varying degrees of risk of developing oncology. It is because of this feature that over 90% of cases of cervical cancer develop. After entering the body, the HPV virus can occur in 3 forms:
- Asymptomatic form;
- Subclinical form;
- clinical form. In the genital area there are multiple or single growths (warts and papillomas).
The most dangerous and with a high level of oncogenic risk are HPV strains carrying markers 16, 18, 45 and 46. The average risk of developing cervical cancer is strains 31, 33, 51, 52 and 58 types.
Other causes of cervical cancer:
- Predisposition. If women among relatives had cases of cervical cancer, then you should be extremely careful about your health and regularly examined;
- Viruses - genital herpes, HIV, chlamydia, cytomegalovirus;
- Untreated or undertreated genital infections;
- Diseases of the cervix, accompanied by changes in tissues (erosion, dysplasia, leukoplakia);
- The presence of benign tumors (myomas, fibromyomas), which, under long-term adverse conditions, can degenerate into malignant, other neoplasms;
- Strong weakening of the immune system;
- Uncontrolled human exposure to radiation, chemical toxins;
- Frequent abortions or curettage, as well as complications associated with these and other surgical procedures;
- Frequently recurring pregnancies and childbirth;
- Microtrauma of the cervix or the uterus itself, as well as the cervical canal;
- Early onset of sexual activity;
- Change of partners more often 2 - 3 times a year;
- long-term stress;
- Uncontrolled intake of oral combined contraceptives;
- Long-term smoking or addiction to alcohol;
- The presence of chronic inflammation in the pelvic area without proper treatment. Other chronic diseases associated with inflammatory processes.
Symptoms
The main and most disturbing symptoms are:
- Unforeseen and frequent bleeding (after a visit to the gynecologist, after sexual intercourse, between normal periods, during menopause);
- Menstrual bleeding lasts more than a week;
- Discharges with blood, they may have an unpleasant odor and signal the onset of tumor decay;
- Purulent discharge with a sharp and unpleasant odor;
- Prolonged cramps (lower abdomen and uterine area);
- Pain that is spasmodic in nature. In this case, part of the pain can be given to the lower back;
- Excessive dryness of the vagina and pain during intercourse;
- Sudden weight loss (10 to 15 kg in a few weeks). This symptom is unconditional and requires prompt medical attention;
- Constant constipation and pain during bowel movements. Other diseases associated with the intestines;
- A sharp increase or vice versa, serious delays in urination. This is due to the growth of the tumor, which compresses the bladder. There may be blood in the urine;
- Constant severe weakness;
- Excessive fatigue;
- Excessive sweating for no apparent reason;
- Slight fever without signs of a cold (between 37°C and 37.8°C);
- Constant swelling of the extremities. This is especially true of the legs and feet;
The symptoms listed above are not a prerequisite, but their presence can also indicate other serious diseases, including gynecological or sexually transmitted diseases. Therefore, do not postpone a visit to a gynecologist.
Diagnostics
Diagnosis of cervical cancer consists of several stages:
- Examination by a gynecologist to detect oncology. It is necessary to pass it 2 times a year;
- Scraping from the surface of the cervix for cytological examination (Pap smear);
- Colposcopy. Examination using a special device that helps to enlarge and zoom in on the image of the tissues of the cervix;
- Biopsy - using this microinvasive method, biomaterial is taken for histological examination;
- Curettage procedure of the cervical canal. It is necessary and carried out only in the case when cytology shows oncology or dysplasia, and colposcopy does not reveal anything;
- Samples for the Schiller test (with vinegar or iodine);
- Examination of the pelvic organs using ultrasound. Allows you to fairly accurately identify the presence or absence of tumor formations. If ultrasound is not enough to determine the exact location and quality of the tumor, then an MRI of the pelvic organs may be prescribed.
If there are several symptoms at once and there are serious suspicions of cervical cancer, the gynecologist may also prescribe related examinations related to other organs to detect metastases:
- Ultrasound of the liver and kidneys;
- Ultrasound examination of the bladder;
- Radiography of the lungs. This is how distant metastases in the chest are detected;
- X-ray of the colon (irrigoscopy);
- Appointment of cystoscopy and rectoscopy. Data from the examination of the bladder and rectum allow us to find out the presence of metastases or tumors that have penetrated into their walls;
- Intravenous urography. Cervical cancer is often accompanied by squeezing of the ureters and leads to serious disorders in the functioning of the kidneys. Up to the development of atrophy of the renal tissues or ureters. This method allows you to identify such violations.
Which doctors to contact
The main doctor conducting examinations and prescribing treatment is a gynecologist. If cancer is found in the process, then an oncologist will additionally need to be observed. Other doctors (therapist, endocrinologist) are visited as needed or in cases of detection or development of other diseases.
Treatment
Methods of treatment largely depend on the degree of development of the disease. Here it must be remembered that, although there are only 5 stages of cancer (including zero), each of them has 2-3 degrees of complexity (categories A or B). The designation depends on the size and location of the tumor:
- Stage 1A1. (invasive stage). The tumor is detected only by microscopic examination. Only the cervix is affected (no metastases). The dimensions do not exceed 7 mm in volume and 3 mm of the lesion in the depth of the epithelium. Treatment is conization (excision of diseased tissue) in young women or traditional hysterectomy (removal) of the uterus in post-menopausal women. With concomitant damage to the lymph nodes or blood vessels, a lymphadenectomy (lymph nodes are removed) of the pelvic area is prescribed. After the operation, radiation therapy is prescribed (may be with or without chemotherapy);
- Stage 1A2 (invasive stage with complications). The tumor is also impossible to detect visually, but when detected, it turns out that its dimensions exceed 7 mm in the width of the lesion and 3 mm in depth. Treatment for patients of childbearing age is excision of the cervix or its conization, and for the elderly, a hysterectomy is prescribed. Pelvic lymphadenectomy is mandatory. If metastases are detected, chemotherapy and radiation therapy are performed;
- Stage 1B The tumor is visually visible, and its size does not exceed 4 cm. Treatment can be 2: surgery with external radiation. In the first case, a radical hysterectomy is performed (removal of the uterus completely with appendages and tubes) and bilateral oophorectomy. A pelvic lymphadenectomy is mandatory and performed. In particularly favorable cases, surgical treatment is carried out with the preservation of all organs. In the second case, the problem is solved by radiosurgery. First, brachytherapy is performed, and after 1.5 - 2 months - the operation itself;
- Stages 1B2 - 5A. the tumor is detected visually, and its size is equal to or slightly exceeds 4 cm. in such a situation, tumor lesions of the vagina, rectum with the bladder are possible. The most optimal treatment is radiation therapy and chemotherapy. ;
- Stage 5B. The area of the lesion and the general size of the tumor can be any. Distant metastases are also present at this stage. At this stage, palliative treatment is carried out.
Follow-up after treatment
All patients who have been diagnosed with cervical cancer and received appropriate treatment should regularly visit a gynecologist and undergo the necessary instrumental and laboratory diagnostics.
Within 2 years after treatment, every 3 months it is necessary to analyze the cytogram. Another 3 years after that, a smear is taken every six months. For the rest of my life, the cytogram is given annually. This is necessary in order to avoid recurrence of the disease.
To control the appearance or development of metastases, as well as for their early detection, MRI, CT and PET of the abdominal cavity and pelvic organs are used.
Prevention
The most effective prevention is recognized as vaccination against the papillomavirus (HPV), as the main primary source of cancer development. It can be done from 9 to 11 years old, since the drugs are most effective if the vaccine is given before the onset of sexual life. So before infection with a virus that is sexually transmitted. It also makes sense to get vaccinated against this virus for all women under 45 years old.
The most studied and effective means of immunization is the Gardasil vaccine (Gardasil). The drug effectively protects against the virus 4 years after vaccination. Then the procedure must be repeated.
Cervical cancer- a malignant disease of the organ of the female reproductive system, intended for the conception of the fetus and for its birth.In the world, about 500 thousand women receive this diagnosis every year and 230 thousand die from this disease. In Russia, the incidence is 15 per 100 thousand women, in the world - 8-12.
The main causes of cervical cancer
Commentary of Barashkova Ekaterina Alekseevna - obstetrician-gynecologist, ultrasound doctor, gynecologist-endocrinologist, reproductologist:
Cervical cancer - this disease has become very common, ranks second in frequency of malignancy after breast cancer and is observed in every 10 women, based on 100 thousand cases.
The harbinger of this malignant neoplasia is the process of transformation of the structure of the cervix, eventually leading to dysplasia of the upper layers of its epithelium. The main cause of cervical cancer is the presence of HPV (human papillomavirus).
In 2008, Harald zur Hausen received the Nobel Prize for the discovery of HPV as the cause of cervical cancer.
Currently, about 150 types of the virus have been identified, all of them are divided into high / medium and low oncogenic types. The culprits for the development of cervical cancer are the most common, highly oncogenic types: 16.18, 26.31, but the list is much longer.
The method of transmission of the virus is sexual intercourse (even protected) with an infected person, or contact through the skin and mucous membranes, and a vertical route of transmission from mother to child during childbirth is also possible if the mother has viral lesions.
After entering the body, HPV introduces its code into the DNA of epithelial cells, and gradually leads to epithelial dysplasia and the development of an oncological process.
How does cervical cancer manifest itself?
- Pathological discharge from the genital tract, which manifests itself for the first time under various circumstances: after sexual intercourse, when lifting weights, when traveling by transport, accompanied by shaking and other mechanical stimuli.
Allocations can be:
- in the form of leucorrhoea (of varying degrees of transparency, watery, slightly yellow discharge), as an indicator of lymph perspiration through the tumor;
- bloody nature of varying degrees of intensity without any connection with the monthly cycle, as an indicator of the growth of the capillary apparatus of the tumor.
The presence of an unpleasant odor from the discharge can be a sign of tumor decay.
- Pain in the lower abdomen with irradiation to the anus, sacrum. It can first appear during intercourse, but it can also occur "for no reason."
- Swelling of the soft tissues of the lower extremities and pelvis. Appears in the late stages of the disease. The reason is the difficulty in the outflow of lymph associated with blockage of the lymph nodes by metastases of cervical cancer.
- Changes in urination: delay (when squeezing ureteral metastases) or increase (due to incomplete emptying of the bladder when the tumor grows into the urethra).
- The appearance of blood in the urine and feces. They appear when the tumor invades neighboring organs.
- The formation of rectal-vaginal fistulas. Manifested by fecal odor and discharge of feces from the vagina. Appears with massive invasion of the tumor into the rectum.
- The formation of vesicovaginal fistulas. When the tumor grows into the lumen of the bladder, the latter communicates with the vagina. In this case, there is a constant excretion of urine from the genital tract.
The last two symptoms appear in late, advanced cases of cervical cancer, may be accompanied by bleeding.
Modern diagnosis of cervical cancer
- Examination of the cervix using speculum and bimanual gynecological examination.
Inspection allows you to visually assess changes in the cervix with tumors growing into the lumen of the vagina. Feeling the cervix allows you to suspect the presence of forms growing in the direction of the body of the uterus.
- Recto-vaginal digital examination.
Detects the spread of the tumor outside the cervix.
- Carrying out the Schiller test.
When Lugol's solution is applied to the cervix, areas with precancerous and early cancerous changes are clearly visible.
- Inspection of suspicious areas with a colposcope.
This allows you to examine suspicious areas in detail at a magnification of 40 times and take smears from them and perform a biopsy for further histological evaluation of altered tissues.
- Apply a blood test for the presence of squamous cell carcinoma antigen - SCC-Ag in the blood.
The study is non-specific, since some of the histological forms of cervical cancer do not give any marker reaction. A positive reaction can also be in the presence of a squamous cell tumor with localization in other organs.
- ultrasound. This method can determine the first signs of a tumor exit outside the cervix to adjacent tissues and organs.
- CT of the pelvic organs.
- Rectoscopy and cystoscopy with the use of contrast agents.
With their help, the degree of germination of cervical cancer in the bladder and rectum at the earliest stages is determined.
- X-ray examination of the chest and ultrasound of the abdominal organs to identify possible distant metastases.